Monday, 29 November 2010

The Swedish National Institute of Public Health (SNIPH) has got itself into hot water after lying accidentally giving the wrong impression to journalists about the health effects of snus.

SNIPH has been waging a vendetta against snus for many years. As you may be aware (if you recall Skoal Bandits), a massively ill-informed burst of prohibitionist fervour in the early 1990s resulted in snus being made illegal in the EU. The reasoning was that it caused oral cancer and was a gateway to smoking. Sweden wisely negotiated an opt-out when it joined the EU in 1995 and since then a mountain of evidence has amassed to show that snus categorically does not cause oral cancer and that is a very effective gateway away from smoking.

The SNIPH would have us believe that the Swedes' incredibly low rate of smoking (just 12%) and correspondingly low rate of lung cancer are in no way way related to the enormous quantities of (basically harmless) snus they consume instead. Nor are they prepared to consider the possibility that if the EU removes its completely arbitrary ban on the world's least hazardous tobacco product, the Swedish experience could be replicated elsewhere.

Having grudgingly accepted that snus doesn't cause mouth cancer (which is intuitively the most likely outcome from a tobacco product used in the mouth), the SNIPH has been on a ten-year fishing expedition to find a 'link' with various other cancers and heart disease.

Last week came a shock new claim. At their conference in Stockholm, the SNIPH announced the results of a new study which showed that snus affects fertility and causes impotency. DN, one of Sweden's biggest newspapers, announced that "nicotine in snus affects potency and also inhibits women's ability to become pregnant." (Article here; translation here.)

This claim came directly from the SNIPH's tobacco control project manager, Asa Lundquist, and generated considerable discussion in Sweden, where over 20% of men are regular snus users. Swedes are used to hearing scare stories about snus (invariably from the SNIPH) and this was no exception. But what makes this scare particularly risible is the fact that the "finding" is a figment of Lundquist's imagination. Although she went on the record to talk about the study, and even approved the DN's article before publication, no such study has ever been conducted and the DN has since printed a correction:

SNIPH backs off on snus and potency

In Wednesday's DN we referred to a new study from the Public Health Institute showing that snus causes erectiledysfunction. No such study exists.

"I nearly fell off my chair when I saw this article," said Stefan Arver, associate professor of endocrinology at the Karolinska Institute. "There is no such study. We have a hypothesis and plan to conduct a study among snus users after the new year."

It's bad enough that researchers announce what they expect to find from a commissioned study (eg. Jill Pell, Manuela Martins-Green). But pretending to have completed the study and making up the result has to be a new low. So please, in the interests of whatever tiny degree of scientific integrity that remains, at least have the decency to begin the research before you start lying to us.

Sunday, 28 November 2010

Frank Davis is currently hosting a debate on the subject of 'Does smoking cause lung cancer?'

Why? Well, why not? It seems that not everyone is convinced by the evidence. So untrustworthy have anti-smoking campaigners been in their handling of science in recent years that it is not surprising that some people find it difficult to believe anything they say.

This, to me, is going too far. The evidence that primary smoking is a major risk factor for lung cancer and several other serious diseases is wholly different in terms of quality and quantity from the junk science we cover on this blog every day. That doesn't mean the claim should be taken on trust, however. Instead, we can look at the evidence and make our own minds up.

Friday, 26 November 2010

The big news today is that secondhand smoke causes 600,000 deaths a year worldwide. Anyone tempted to take this figure remotely seriously should bear in mind that the authors of the associated study also believe that "smoke-free laws banning smoking in indoor workplaces rapidly reduce numbers of acute coronary events" and "fully smoke-free policies have a net positive effect on businesses." And, interestingly in the light of the Moral Maze the other night, they consider the main aim of smoking bans to be denormalisation:

Above all, [smoke-free] policies contribute decisively to denormalise smoking, and help with the approval and implementation of other policies that reduce tobacco demand, such as increased tobacco taxes and a comprehensive ban of tobacco advertising, promotion, and sponsorship.

Still, you can't fault their impeccable methodology:

To identify national data for second-hand smoke, the keywords “second hand smoke”, “environmental tobacco smoke”, and “passive smoking” were combined with names of countries or regions, by searching Google and the PubMed database

The spirit of Newton and Darwin lives on, does it not?

What can be said of the 600,000 estimate? Obviously if you extrapolate a relative risk over a larger population, you will get a larger number. That doesn't make the study or studies you are extrapolating from any better, but I won't risk waking this blog's resident troll by going into all that again.

It's interesting that this study appeared in the Lancet because back in the 1990s, Lancet columnist Petr Skrabanek* remarked on the tendency of public health campaigners to use larger and larger populations to get scarier and scarier death counts. He called them "jumbo-jet numbers" because talking about the equivalent number of jumbo-jets that would have to crash for the same death toll sounds more dramatic than explaining that you have to die of something and that most of the people being "killed" were very old. This, from a collection his articles [PDF]:

The intoxication with numbers is another characteristic of the modern crusaders against smoking. They typically use big population blocks as denominators to obtain bigger and bigger numbers. Richard Peto, a leading anti-smoking exponent and a statistician, announced that 'of all children alive today in China under the age of 20 years, 50 million will eventually be killed by tobacco.' This would put the hecatombs of the Second World War in the shade. The British Medical Journal referring to another such statistic, 'typical of the Oxford epidemiologist Richard Peto', quoted that 'about 20 million children now living in Europe will be killed by tobacco in their middle age.' And The Times reported on January 1, 1988, that according to Mrs Risk-factor Epidemiology: Science or Non-science?

Edwina Currie, 'more than a million schoolchildren and 60,000 babies born this year will die of smoking-related diseases such as lung cancer.' Surprisingly, no-one has yet used the population of the whole world as a denominator: this would produce numbers of babies, toddlers, schoolchildren, and other children, killed by tobacco in truly phenomenal ranges. Perhaps the reason for this reticence is the fear of overkill.

Well, now they have. In fact, they've missed a trick by not using the other PR tool of multiplying by years (eg. here). So, to save someone the trouble, here's my study:

Conclusion: Secondhand smoke will kill 6 million people over the next ten years. Where's my cheque?

[*nb. Petr Skrabanek was a skeptic about—amongst many other things—secondhand smoke. You can probably guess what the anti-smokers' response was. That's right, they accused him of working for the tobacco industry. Which was a lie. He died of a non-smoking related disease in 1994.]

The subject of Wednesday's Moral Maze was Nudge by Thaler and Sunstein. They argue (compellingly) that it would be nice if we could set society up so the things that 99% of people want to do were the default setting, but if you don't want to do them, it would be a piece of cake to opt out. For example, companies in the US (the authors are from America—this is important) might offer free health insurance but you have to opt in to claim it. Thaler and Sunstein suggest changing things round so you're automatically given the insurance but can opt out if you want.

Who could complain? Pretty much nobody, right? And who could complain at the idea of having sunbeds switch themselves off after 10 minutes in case you fall asleep under them, or driving license renewal forms that ask you if you would like to give your organs to someone who needs them should you perish prematurely?

I consider myself to be basically a libertarian and I can't muster up any arguments against these things, and this really is as far as Nudge (the book) goes. The authors spend several page fretting over whether governments have the right to force motorcyclists to wear crash helmets, for God's sake. These people would be considered virtually anarchists in Britain.

All this seems to have passed a lot of people by. It nearly passed me by. As I mentioned in my review of it in August, the very fact that 'nudging' has been adopted by the likes of Julian Le Grand was sufficient to put me off it for several years. I'm very pleased I finally relented since it's a good addition to the library of behavioural economics. It's also 95% libertarian and only 5% paternalism.

Whilst I would never be so indelicate as to suggest that not everybody involved with the Moral Maze on Wednesday night had read the book, the whole format did rather hinge on its co-author Richard Thaler being an authoritarian wolf in libertarian sheep's clothing.

This was apparent from the choice of guests. With the panel broadly splitting in half, with Portillo and Phillips roughly in the libertarian camp (yes, very roughly - don't write in) and Taylor and Longley roughly in the paternalism camp. Since Delingpole and I are fairly obviously with the libs, and the lady from the Roy Castle Foundation with the paternalists, to even up the numbers the other witness would have to be a paternalist.

The trouble was that the other guest was Thaler himself and—as very quickly became apparent—he is anything but. Accused of trying to change people's goals, he said:

"I don't think we could have possibly been any more clear that that's completely wrong."

Lest that still not be clear enough, the sublimely incredulous Thaler responded to further insinuations of social engineering by saying:

"Absolutely not. There is nothing that could be wronger than that."

Listening in the green room, I said to James Delingpole that I didn't think they were quite going to get the argument they wanted out of this discussion. (Towards the end of the show, Michael Portillo drily noted that Thaler "didn't stand for some of the things we thought he stood for.") Thaler went on to strongly deny wanting presumed consent for organ donation, and when asked about plain-packaging, explained once more that he didn't approve of bans at all.

There may be tea-partying parts of America where this sort of talk is considered paternalistic, but then Americans take their liberties a bit more seriously than we do. By the standards of British politics, let alone European politics, Thaler would be classed a loony libertarian. Nevertheless, the format of the show assumed that Delingpole and I would violently disagree with him and his supposedly authoritarian-by-the-back-door ways. This we could not do. Delingpole praised Thaler's sensible book and lamented the way it had been perverted by politicians. He also quite rightly picked Matthew Taylor up on his elitist assumption that the world is divided up into "sophisticated and intelligent" people who are capable of making informed decisions and a lumpen mass of imbeciles who are constantly manipulated by malign institutions for profit.

When it was my turn to be interrogated, Longley wondered with exasperation why I was so opposed to Nudge. I wasn't, I said, although by this time I was tempted to add "... but I can pretend to be if it would help things." Some readers of this blog noticed that I was interrupted quite a bit by Longley and Taylor (the latter chaired The Spirit Level debate at the RSA), something which is more apparent to me listening back than it was at the time. I can't say that I thought the questioning was any more aggressive than in the average Moral Maze. The whole point is to have a bit of an argument and for all three of us, this was more than a rhetorical contest.

Longley believed that the government had decided that smoking was abnormal and anti-social and was going to do something about it. Essentially, he espoused absolute democracy, in which once a government had been elected, it had a mandate to do whatever it wants. Obviously I disagree, since I believe in liberal democracy, which accepts that since democracy is imperfect, elected governments should work within limits (eg. unwritten limits in Britain, written limits in the USA). In any case, using the absolute democracy argument is particularly weak when talking about contemporary Britain where you have a government nobody voted for, made up of two parties which promised less regulation and the overturn of the tobacco display ban.

Anyway, you don't need me to explain what was said as you can listen here, but I hope that the message came over on Wednesday night that Nudge does not in any way justify the kind of lifestyle policies that all the main British political parties have been going along with in recent decades. The Nudge philosophy is totally at odds with every public health initiative that goes beyond giving accurate advice and information to people who want it.

'Nudging' is not a cute name for 'do what we say'. As Thaler and Sunstein consistently stress, any nudging must have a cost to liberty that is close to zero and a financial cost that is close to zero. In other words, goodbye smoking ban, farewell minimum pricing and adios fat tax.

If the coalition is serious about cutting regulation, adopting Nudge would be a sound textbook to work from. But as we have already seen from plain-packaging and the farce of the YourFreedom website, they have no intention whatsoever of doing that. So, if anyone in politics ever gets round to actually reading the bloody book, it much more likely to be farewell Nudge.

Thursday, 25 November 2010

Thanks to all who listened to and commented on last night's show, which can be listened to here for 7 days. I'll have some final thoughts on libertarian paternalism later today but first I have a broken boiler to attend to.

As a quick aside, however, I see the BBC has described me on its website as:

Chris Snowdon: Smoker and author of 'Velvet Glove Iron Fist; A History of Anti-Smoking'

Does this suggest that smoking is now so rare and exotic that it's worth calling attention to? (There are only 1.2 billion of us after all.)

Or is smoking now classed as an occupation? If so, I'd just like to say that I'm available for work, I have my own lighter and I'm prepared to travel.

Tuesday, 23 November 2010

Tomorrow evening I'll be appearing on BBC Radio 4's Moral Maze programme which will be discussing 'libertarian paternalism' and the so-called 'Nudge agenda'. Details are here:

How far should we go to stop people doing something that's bad for them?

We know cigarettes are very likely to cause you serious illness and could even kill you. The tricky thing is many people find them extremely enjoyable and they're perfectly legal. The government, frustrated that some people still persist in choosing to exercise their right to pursue a perfectly legal activity, despite decades of health education, bans on advertising and smoking in public places, are looking at forcing tobacco manufacturers to sell cigarettes in plain packaging.

The problem is that all those people exercising their freedom to smoke are then clogging up the NHS demanding that the rest of us pay for the treatment of their self inflicted illnesses. It's a question not just for smokers. How do you feel about a fat tax, or a minimum price for alcohol?

Tax is a bit of a blunt instrument and unpopular with voters, so it's not surprising that politicians have latched on to "nudge economics". Behind the doors of Number 10 there's a unit called The Behavioural Insight Team that talks about finding intelligent ways to encourage people to make better choices for themselves.

Is this an example of paternalist libertarianism - preserving people's freedoms while at the same time minimising their impact on the wider society? Or a worrying Orwellian development where politicians have given up trying to win the political argument and have instead just resorted to employing teams of psychologists and marketing executives to manipulate our behaviour?

If we're too stupid for our own good, why should we worry if politics becomes the equivalent of potty training? How far should we go to stop people doing something that's bad for them?

Expect plain packaging, smoking bans, temperance crusaders and other frequent offenders from this blog to get a mention.

If politicians stuck to both the spirit and the letter of Thaler and Sunstein's philosophy, the nudge agenda would be largely benign and almost certainly beneficial. Far from supporting the kind of policies being pursued by the UK Faculty of Health, any British government that was genuinely committed to the Nudge agenda would have no choice but to repeal whole swaths of legislation that already cross the line between libertarianism and paternalism.

Monday, 22 November 2010

"By helping smokers who want to quit and protecting our children from the tobacco ad men this will be an enormous leap forward for public health, perhaps even bigger than the smoking ban," he said.

He was talking about the crazy plain-packaging ruse, but he would have said the same thing whatever the policy was. Fair enough, that's his job. If he weighed up the pro's and con's of each policy and then gave a reasoned and intelligent assessment, he'd soon find himself in a smokefree Jobcentre.

But by saying that plain-packaging could be an "even bigger" leap forward for public health than the smoking ban, he is clearly suggesting that the smoking ban was itself a leap forward. This is frequently stated by all sorts of people, and it is often assumed that the smoking ban led to a surge in people giving up smoking. But has it?

"Encouraging" smokers to give up was, of course, the true (and barely concealed) motive for bringing in the ban in the first place and woe betide anyone who cast doubt on whether this would really happen back in July 2007. In ASH's hilariously premature and ill-founded Myths and Realities of a Smokefree England document (which I wrote about at t'old place) they said that the idea that mass abstinence wouldn't happen was a "myth".

We haven't heard much about smoking prevalence since (the statistics for such thing are always slow in coming forth), so I'm grateful to regular reader Dave Atherton for sending me the Office of National Statistics' Life Style Survey 2008 (published 2010), which concludes:

The overall prevalence of smoking among the adult population was the same in 2008 as it was in 2007 at 21 per cent.

A similar phenomenon was found by the EU's Eurobarometer which found the UK's total proportion of smokers (all forms of tobacco) to be 28% in 2009, which is—again—exactly the same as it was in 2008.

And all after the biggest, most controversial, most costly and most socially divisive piece of tobacco regulation in British history. Good work guys. Have the rest of the day off.

The other thing the ONS's report shows is something that Dick Puddlecote and I often point out—drinking is not on the increase in the UK:

Following an increase between 1998 and 2000, there has been a decline since 2002 in the proportion of men drinking more than 21 units a week, on average, and in the proportion of women drinking more than 14 units

That's yer "hazardous" consumption. This is overall consumption:

The average number of units of alcohol consumed in a week rose steadily in the 1990s and achieved a peak of around 17 units for men and 7.5 units for women in the period 2000 to 2002. These levels fell to 14.8 units for men and 6.2 units for women in 2006. The revised methodology shows that the average number of units consumed is continuing to fall from 18.7 for men and 9.0 for women in 2006 to 16.7 and 8.4 respectively in 2008.

So, to summarise:

Rates of drinking are falling and have been for years

The smoking ban had no impact on the number of people who smoked, unless by "impact" you mean "put an end to a ten-year decline"

I mention this just in case any journalists or single-issue activists accidentally give you completely the opposite impression.

I think it was Roger Daltry who sang something about meeting the new boss. Other people have said that patriotism is the last refuge of a scoundrel. I'm not so sure. I think scoundrels can sink much lower than that when they need to. See if you can see a theme running through the feeble claims for this latest piece of Sovietisation...

The government is currently planning to ask retailers to cover up their displays of cigarettes from next year to protect children. But now cigarette packets could also be made a standard colour like grey, rather than the existing bright colours.

Campaign group ASH says this is "an enormous leap forward". The Department of Health is considering the idea of asking ['asking' as in "we'll fine, bankrupt and imprison you if you don't agree" - CS] tobacco firms to put only basic information and health or picture warnings on their packets.

Making the cigarette packets a plain colour would protect children from taking up smoking in the first place, it suggests. It would also help support people who are trying to give up smoking, the department said.

Health Secretary Andrew Lansley, said it was time to try a new approach. "The evidence is clear that packaging helps to recruit smokers, so it makes sense to consider having less attractive packaging. It's wrong that children are being attracted to smoke by glitzy designs on packets.

"We would prefer it if people did not smoke and adults will still be able to buy cigarettes, but children should be protected from the start. The levels of poor health and deaths from smoking are still far too high, and the cost to the NHS and the economy is vast. That money could be used to educate our children and treat cancer," Mr Lansley said.

"We will shortly set out a radical new approach to public health in a White Paper."

Martin Dockrell, director of policy and research at ASH, (Action on Smoking and Health), said the industry calls packaging "the silent salesman".

"They use it to seduce our kids and mislead smokers into the false belief that a cigarette in a blue pack is somehow less deadly than a cigarette in a red one.

"By helping smokers who want to quit and protecting our children from the tobacco ad men this will be an enormous leap forward for public health, perhaps even bigger than the smoking ban," he said.

I am so tired of this unceasing nonsense that I can barely summon up the energy to mention that children have not been allowed to buy cigarettes since 1906. It seems barely worthwhile to point out that 40% of cigarette packs are already made up of warnings which say 'Smoking Kills'. There is no use in saying that colours and logos alone cannot "seduce" anyone. And it is futile to note that any government that forms policy on the back of hysterical yelps about protecting children treats all its citizens as children.

The wish-list of anti-smoking extremists is long and publicly available. It should be no more a surprise that they want plain packaging of cigarettes than it is that Los Angeles is calling for a total ban on smoking outside the home. These policies have been discussed in hushed tones at tobacco control conferences for several years, and it is, of course, their job to come up with wild, new directions for tobacco control.

It is also—so we thought—the job of elected politicians to tell fanatics and nut-jobs where to get off. But that is no longer the case, and the anti-smoking fraternity must be pinching themselves when they hear their fruitiest schemes being discussed by a nation's Minster for Health.

In truth, the coalition of the unwilling, like every government in recent memory, will use "tough" (but ultimately pointless and counter-productive) measures on smoking as a distraction from its failure to do anything about real issues. It's pathetic and predictable, but that's how it is. Evidence, logic and ethics don't come into it. It's simple politics and those of us who didn't vote Conservative at the election should feel vindicated today.

UPDATE: A tweet from Leeds University's Faculty of Medicine of Health rather gives the game away:

That's first step, you will notice. Not even 'next logical step'. Truly, they haven't even begun.

Friday, 19 November 2010

The BMJ's Tobacco Controlblog provides a good example of why top-down prohibitionist campaigns struggle on the internet. No doubt they've all seen the memo telling them about the importance of engaging with the online audience, but when your movement is fundamentally elitist, engaging with the wider world has its problems.

There is the issue of not having very much to say, even though—unlike 99.9% of bloggers—that is your job. To be fair, this is also true of corporations which decide it would be a swell idea to start a blog. More serious, perhaps, is the problem that you and your colleagues are less-than-typical members of society. This can be ignored whilst chatting over the salad bowl at a public health conference, where views differ by only small degrees, but when thrust into the wider world, the chasm between you and civil society suddenly becomes visible. If you start blogging, not only will people see you in your less guarded moments, but they will also be able to talk back at you.

A recent feature on the Tobacco Control blog highlighted these problems. 'Word wars and tobacco control: choose the winner' (the first entry for six weeks, natch) invited readers to suggest words to describe tobacco controllers and their opponents. This led to problems. Firstly, a number of smokers and libertarians offered up less-than-flattering words to describe the, er, tireless champions of public health, and, secondly, a number of supporters responded with such enthusiasm that they almost seemed to be doing a parody of the stereotypical swivel-eyed anti-smoking zealot.

The comments system were swiftly deleted, but the zealotry remains online (at the time of writing). And perhaps it is a parody. How else can we explain gems like this?

Tobacco company - Suicide facilitation organization.

Growth (noun) - A measurement of suffering and death achievement as well as mortal collateral damage

Lezak Shallat: In my experience, there is a real clash of discourses between the language we use in tobacco control and the language we should be using to reach out to potential (and much needed) allies in the women’s movement. This raises a linguistic and ideological barrier that impedes greater collaboration. A case in point is the concept of tobacco “control”. For the TC movement, the word “control” encompasses a strategy to focus on a product and not its users (smokers) by setting limits that protect the rights of non-users. Within the TC movement, there is little talk of “anti-tobacco” measures or policies. This abbreviated terminology is reserved for headlines and journalists. Among feminists, however, the word “control” raises hives. It is located at the opposite end of the spectrum from autonomy over one’s body and the right to decide for oneself about work, education, reproductive life and more. This idea is central to feminism, and has been successfully exploited by the tobacco industry as a concept to sell cigarettes. The discourses clash. Control vs. protection; freedom to chose vs. informed choice; promoting vs. exploiting aspirations of “autonomy.” These words carry ideological subtexts that hinder greater dialogue with the feminists about how to address smoking as a women’s health issue.

Keen to find out more about the author of this riveting prose, I did a quick Google search which turned up this page, which happened to be hosting a particularly unfortunate, but possibly apt, banner campaign.

I also turned up this page which—if you'll excuse another cheap giggle—explained that:

Although she was named Leza K. at birth, she dropped the space and changed her byline to Lezak Shallat after discovering that, in Spanish, the word "lesa," roughly translated, means "idiotic."

A wise move since she "writes about social justice issues from Latin America" and lives in Chile. Of course, if she lived in the English-speaking world, the name Leza wouldn't be funny at all, would it?

And how about this from the real-life prohibitionist "Terence A. Gerace, Ed.M., M.A., Ph.D." (Who feels the need to put that many letters after his name on a blog comment?)

The terms Big Tobacco, tobacco industry, and major tobacco companies should be eliminated in favor of “toxic-tobacco companies” or “toxic-tobacco industry”. None of the former terms provides the true negative denotation that “toxic-tobacco companies” and “toxic-tobacco industry” do. Placing “Big” in front of Tobacco blunts tobacco’s negative associations. “Big” has a positive connotation as evidenced by McDonalds Corporation’s using “Big” in front of “Mac” and Frito-Lay placing “Big” before “Grab” to designate its large bag of snacks for individuals.

The idea that calling tobacco industries 'Big Tobacco' "blunts tobacco's negative associations" is plainly nonsense. The whole reason why the term Big Tobacco was coined by anti-smokers in the first place was to (a) perpetuate the David vs Goliath myth which portrays the anti-tobacco industry as brave pygmies against a behemoth, and (b) to rally those who instinctively dislike big business.

Getting rid of the 'Big' in Big Tobacco is fine with me. I've never understood why cigarettes from large companies should be worse than any others. But let's not pretend this is anything other than rebranding for the sake of it, and rebranding is always a sign of failure. Whether it's the post office changing its name to Consignia or socialists calling themselves liberals, the purpose of rebranding is to move away from a toxic brand.

The desire to rebrand is particularly urgent amongst tobacco controllers, since they are gripped by the delusion that the tobacco industry invented the very terms they are forced to use. This is sheer paranoia. I have heard it said that the industry invented the word 'anti-smoking' as a pejorative term. Apart from the fact that it is an entirely neutral word for people who are against smoking, the enemies of tobacco called themselves 'anti-smoking leagues' a hundred years ago. Lennox Johnson called himself an anti-smoker in the 1940s (see Chapter 4 of Velvet Glove, Iron Fist). If anti-smoking has a pejorative context today, it is because the public have seen what anti-smokers say and do, and they don't like it.

The anti-smoking movement (sorry—'tobacco control movement') would prefer it if everyone called smokeless tobacco 'spit tobacco' because it sounds more disgusting. They would no doubt prefer the tobacco industry to be known as 'the swine' and cigarettes to be known as 'Satan's death truncheons'. Alas for them, 'tobacco industry' is a more informative, balanced and descriptive term for an industry that makes tobacco, 'cigarettes' are small cigars that gained popularity in Revolutionary France and most smokeless tobacco products don't involve spitting. And since language is there to describe rather than propagandise, that'll just have to do.

UPDATE: As Leg-Iron reported last week, Junican submitted a spoof suggestion which succeeded in being slightly less deranged than the genuine offerings and now seems set to win him the "prize" of a one year online subscription to Tobacco Control (God knows what the second prize is).

Two weeks ago Smokles told us the tragi-comic story of Errol Povah (above). Povah is a very rare breed— a genuine unpaid anti-smoking activist. The 57-year old Canadian set off on a coast-to-coast run/jog/walk intending to raise $47,000 for his nutty pressure group and "put the entire smoking industry out of business."

Povah's ambitious plan involves arriving at Philip Morris's New York headquarters later this month where he no doubt intends to carry out some sort of protest (yes, he's one of those who dresses up as the grim reaper). As Carl Phillips pointed out, the choice of route holds certain problems since Philip Morris moved to Richmond (400 miles away) several years ago. And his problems don't end there...

Originally, he said, he wanted to raise $540,000 - a dime for each of the world's 5.4 million people who die from tobacco annually. But money has been tight.

This is so true. As of today, Povah has raised a little over ten percent of his reduced target, and when we last heard from him, the dearth of donations was becoming a burden.

“It’s a huge struggle,” Povah said from Ottawa Tuesday, adding the lack of support crew or sponsors is a major disappointment.

Forced to travel alone, Povah has had to conduct his marathan journey in a highly unsatisfactory, half-arsed manner:

Because he has to bring his van along, and has no one helping him, he has to walk forward a certain distance, then go back for his van. At the end of the day, having advanced 26.2 miles but having walked twice that, he drives the van another 26.2 miles forward to account for the miles he had to walk in the wrong direction.

"I literally can't afford to buy new shoes," he said, after finishing a 26.2-mile walk on Tuesday from Warrensburg to Glens Falls. "I'm flat broke at the moment. I have to get some money organized."

This pitiful tale provides a stark reminder—especially to him—that the anti-smoking "movement" has not been funded by voluntary donations for a very long time. Aside from one or two sugar daddies (Povah hopes to rope in Mike Bloomberg when he gets to NY), it is funded by the state and Big Pharma while the public looks on in apathy.

Far from bringing down the tobacco industry, Povah's quixotic expedition is an embarrassment for anti-tobacco because it highlights the lack of support it has from civil society. If the public was supportive, they'd get their hands in their pockets and not let this man have to go back and forth to his van every day. You'd think the billion dollar anti-tobacco industry would throw him a few thousand dollars just to spare their blushes.

Instead this chump jogs his way towards an early grave to raise the kind of money that professional anti-smokers wouldn't bother to pick up if it fell in the street, while quack researchers pick up millions of dollars to sit around conjuring up voodoo science in California.

Thursday, 18 November 2010

Brendan O'Neil has written a great piece at Spiked about the frankly fascistic tendency of students to stamp out free speech on campus. Public shamings, book burnings, intimidation of journalists—all the things that were so popular in Berlin 70 years ago. And all in the name of political correctness and all to prevent anyone getting offended by anything.

This has been a long time coming, as his interviewee Greg Lukianoff explains:

"I always like to put the Buddhist argument for freedom of speech", says Lukianoff. "Buddhists believe life is pain and they have a point. You do someone a tremendous disservice if you teach them that pain in life is a distortion of life. Because as soon as you start seeing hurtful things as being aberrations rather than part of normal human existence, then you start to see robust debate and disagreement as a distortion of the human experience rather than a part of the human experience. When you have students graduating from college believing that it is really, really bad if they have their feelings hurt, you are crippling them, you are preventing them from being able to deal with everyday life and debate."

Colleges have become Meccas of politically correct bullshit where what you say and maybe even what you think is being controlled by anti-freedom weasles. Colleges and the ideas they're supposed to represent are being crushed like beer cans. Crushed by one word. A word that students are brain-washed into repeating like a hare krishna chant. Diversity.

The video's worth watching, but if you're pushed for time go from 8.25 and watch the berk in the beret.

Because of the significance of secondhand smoke (SHS) to the anti-smoking movement in the last thirty years, part of my research when writing Velvet Glove, Iron Fist was to read all the studies relating to SHS and lung cancer. Not just the numerous reports, meta-analyses and summaries which informed the political debate, but the studies themselves which showed the real evidence. Taken together, they provide a far more (for want of a stronger word) equivocal view of the science than is routinely presented by campaigners. In fact, it's difficult to imagine so many conflicting studies showing weak or negative associations being cited as "overwhelming" evidence in a less politicised field of epidemiology.

My annotated list of these studies can be downloaded here and most of the full papers can be read online, so I'll leave the interested reader to make up their own mind, but one question that has been raised is why so many of them are from the '80s and '90s and why are so few of them from the last five years?

The answer, quite simply, is that with SHS popularly recognised as lethal, there is little incentive to carry out further research. Researchers follow research grants and today—with private homes now the focus of anti-smoking campaigns—the big money is to be made in thirdhand smoke, childhood exposure and maternal smoking research.

Studies that produce epidemiological evidence for SHS exposure to adults in normal settings are now few and far between. They tend to include SHS as one possible hazard amongst many and/or receive minimal press attention.

Amongst the latter category, we could include last year's Tse study ('Environmental Tobacco Smoke and Lung Cancer Among Chinese Nonsmoking Males: Might Adenocarcinoma Be the Culprit?', American Journal of Epidemiology) which found no statistically significant increase in lung cancer risk for passive smokers in either the home or the workplace. As with Neuberger, this 'unhelpful' finding was brushed over in the text of the study by authors, and while they gamely tried to find a stronger (but still nonsignificant) association with adenocarcinoma (which is the type of lung cancer least associated with smoking), this was not a study that received a big press release.

And now—well-spotted by Dick Puddlecote, since it received no press attention—comes another null study. This one (D. Brenner, 'Lung cancer risk in never-smokers: a population-based case-control study of epidemiologic risk factors', BMC Cancer, 2010) found precisely zero increased risk of lung cancer from either childhood or adult exposure to SHS (1.0 95% CI: 0.6-1.8, and 1.0 95% CI: 0.5-2.0 respectively) and no statistically significant increase for workplace exposure (1.2 95% CI: 0.7-2.0). It did, however, find a near-trebling of risk for exposure to paints and solvents (2.8 95% CI: 1.6-5.0) and for exposure to smoke-soot and exhaust (2.8 95% CI: 1.4-5.3). The authors conclude:

Our results support the concept that exposure to exhaust fumes and or soot/smoke (from non-tobacco sources) is a source of carcinogenic exposure.

This study is—or should be—of particular interest since its sample group is unusually large, comprising some 445 lung cancer cases. This puts it high in the rankings of large, well-conducted studies (size being very important when it comes to accurately quantifying risk).

Instead, this study—like most others that fail to support the passive smoking theory—has gone largely unnoticed because, as we all know, 'the debate is over'.

Wednesday, 17 November 2010

I read a piece in Sunday’s Observer newspaper supporting a letter from anti-tobacco campaigners that appeared in the paper on the same day. Presumably there were concerns among some quarters that the letter did not go far enough, so Observer churnalist Jamie Doward adds another offering in his long-line of pro-ASH articles to strengthen the message. As with all anti-tobacco non-stories, the absence of content is made up for with fatuous claims and think-of-the-children squeals.

The words of ASH's Martin Dockrell—a say-anything anti-smoking zealot if ever there was one—feature prominently:

"The tobacco industry has tried to scare small shopkeepers into campaigning on their behalf, using them as a human shield," Dockrell said. "Their main tactic has been to promote the myth that putting point-of-sale displays out of sight somehow encourages smugglers but international evidence shows that to be false."

Er, no it doesn't Dockrell, you little tinker. Since Ireland and Canada have the worst tobacco smuggling problems in the world, there is a pretty good prima facie case for saying that display bans do lead to smuggling. But even if one questions whether this, in itself, proves that display bans lead to smuggling, it would be bonkers to say that this evidence disproves it.

What there can be no doubt about is that tobacco display bans do not achieve their intended aim of lowering underage smoking (which, one tires of saying, is already illegal). There is crystal clear evidence from every province of Canada that display bans have, if anything, had the opposite effect. Both the Conservatives and the Lib Dems, having examined the evidence used by the previous government to justify a ban on displays of tobacco in shops, and said in opposition that they were opposed to the policy. Its pointless, they said. They were right. And since it will manifestly place an unjustifiable burden on small shops, there can be no justification for a piece of legislation that will uglify and Sovietise thousands of shops. It is the very definition of ‘bad regulation’—and that's before we even mention the basic liberty of displaying a legal product in a free society or the inevitable encouragement a display ban would give the temperance lobby which would love nothing better than to put alcohol out of sight as well.

Having pledged to review the measure if and when they won the election, the Conservatives, and Health Minister Andrew Lansley in particular, is being held to ransom by the anti-tobacco lobby who—having nothing new to say—are rolling out severely compromised individuals like Peter Kellner and indentured moral entrepreneurs like Martin Dockrell.

Why the reluctance to give up on a policy which everyone knows won’t do what it's intended to do, and will instead create a raft of other problems? The answer, surely, is that the powerful anti-tobacco lobby risks losing motivation and momentum over this displays debate. They’re scared that if just one of the measures on their agenda isn’t implemented then the whole tapestry will unravel. As long as professional anti-smokers are mistaken for health campaigners, politicians will continue to be nervous of displeasing them. But they should, because there are no votes to be gained from pursuing Labour's nanny/bully state and doing anything other than scrapping this stupid law will make a mockery of the coalition's claim to be in favour of scrapping unnecessary and illiberal legislation.

There is a lot of sympathy with the independent retailer—rightly so—and this has been a major, unforeseen stumbling block for the tobacco control lobby. At first, some initial effort was made to address the concerns of retailers. That was followed by a campaign to undermine retailers with a positively shameful attempt to skew the evidence about the impact this policy would have on small shops. There was even a protracted, fruitless search for a retailer who might stand up and make supportive noises that chime with those of the anti-tobacco lobby:

26/2/09
Cancer Research UK and the Department of Health attempt to drum up some support for the controversial ban. An e-mail from Elspeth Lee (to a number of unnamed recipients at the DH) illustrates how unpopular the measure is with retailers:

“The coalition is (still) trying to ﬁnd one or two supportive retailers who would be happy to show support in further oral or written brieﬁngs or even do more, but we are failing miserably. Someone today mentioned that DH might have some warmer contacts - are there any that we could follow up with?”

However, these “warmer contacts” turn out to be supermarkets who can expect to proﬁt from the disappearance of large numbers of smaller shops, as Lucy Holdstock explains:

“It’s the bigger chains who are not too fussed about this, at least in private. However, that could work against us as the criticisms are all about costs to smaller businesses.”

What we’ve seen this weekend is an attempt to simply airbrush retailers out of the equation. ASH, enabled by supportive (and lazy) hacks like Jamie Doward, present a picture of big tobacco companies fiercely lobbying the new government and forcing a U-turn on the strength of flawed evidence relating to the illicit market. Neither the letter from the four anti-tobacco campaigners in Sunday's Observer, nor Doward’s article, mentions the monumentous and unprecedented campaign by retailers and shop owners against these proposals.

Of course, few people will be surprised that ASH and their supporters are once again manipulating and misrepresenting a situation to achieve their own aims – after all, they’ve done it before. ASH Director Deborah Arnott boasted that, “Campaigning of this kind is literally a confidence trick: the appearance of confidence both creates confidence and demoralises the opposition.”

The government, even those members of the coalition who read the Observer, will not be so easily fooled this time around. Most MPs will no doubt have spoken to retailers in their constituency, concerned over the display ban; many MPs have looked into the evidence for themselves and concluded that there are far better, far more effective ways to prevent young people smoking than merely hiding it from their view when they go shopping. After years of bullying, cajoling and broken promises, a degree of bullshit fatigue must be setting in when politicians deal with groups like ASH.

The allusion is, of course, to the mythical stratagem whereby the Greeks infiltrated the city of Troy inside a giant wooden horse. The Trojan Number is thus one of several stratagems by which authors get their articles or propaganda into the media.

The most common type of Trojan Number is the one generated by taking one small figure from a dubious study and extrapolating it over a vast population. But in this case, even when you do that, the net benefit is feeble. 275,000 years spread across 52 million is only 1.895 days of extra "good health" per person. In effect, they want us to pay more tax on food for the rest of our lives so we can have the equivalent of an extra weekend of "good health" (whatever that means). Since most of us will tolerate a weekend of poor health for the sake of one good Friday night, this does not sound like a great exchange.

Even if we assume (as we surely must) that the benefit would be only to the quarter of the population who are (tenuously described as) 'obese', that is still only an extra week of good health per fatty. Could the OECD not find something better to do with its time than campaign for this piddling and almost certainly fictitious improvement in public health?

Government measures to change diet are supported in the study by experts at the Organisation for Economic Co-operation and Development and the World Health Organisation.

None of whom are elected, and all of whom should keep their opinions to themselves.

A key proposal suggests treating foods high in fat, salt and sugar in the same way as tobacco, where advertising is restricted and price has been pushed up to discourage use.

You don't need me to remind you that public health spokesmen in days gone by swore on a stack of bibles that this kind of slippery-slope did not exist because cigarettes were a "unique hazard". So let's move on...

Researchers found that a combined approach of taxing unhealthy foods, subsidising healthy options, restricting food advertising and improving labelling was cheaper than simply treating those who develop heart disease or cancer as a result of an unhealthy diet.

The study in question is behind a pay-wall at The Lancet and I cannot vouch for whether the Daily Mail is accurately reporting its contents. But health reporting rarely strays far from the official press release and it certainly sounds like the kind of thing the British Medical Journal's ugly little brother would publish.

And they can both whistle dixie because, as The Guardianreports today...

Using the pricing of food or alcohol to change consumption has been ruled out.

Hurrah! And furthermore...

The Department of Health is putting the fast food companies McDonald's and KFC and processed food and drink manufacturers such as PepsiCo, Kellogg's, Unilever, Mars and Diageo at the heart of writing government policy on obesity, alcohol and diet-related disease, the Guardian has learned.

In your face, Organisation for Economic Co-operation and Development!

This Guardian 'exclusive' will doubtless make its readers choke on their breakfast muesli, and I'm not keen on having industry dictating policy myself, but in this instance I really can't see what McDonalds are going to suggest that will limit freedom or shaft consumers. And it gets better...

The alcohol responsibility deal network is chaired by the head of the lobby group the Wine and Spirit Trade Association.

Get in! This sounds almost too good to be true and, needless to say, the fake charities and temperance nuts are none too happy...

A member of the alcohol responsibility deal network, [Sir Ian] Gilmore said he had decided to co-operate, but he doubted whether there could be "a meaningful convergence between the interests of industry and public health since the priority of the drinks industry was to make money for shareholders while public health demanded a cut in consumption".

You're in no position to demand anything, my friend, and it's that kind of talk that has worn out the public's patience with you and your ilk.

Jeanette Longfield, head of the food campaign group Sustain, said: "This is the equivalent of putting the tobacco industry in charge of smoke-free spaces."

Yesterday, I suggested that the Serbian smoking ban was not particularly rigorous when compared to the draconian legislation of the English-speaking world. The Serbs, it seems, do not agree.

Tobacco-loving Serbs fume over smoking ban

The article goes on to explain Serbian outrage at a ban that allows smoking in small bars and only requires nonsmoking sections in large bars.

Perhaps it's the use of the word "lamented"in this next sentence, but somehow it paints a more poignant picture than could be captured in any photograph...

Neven Boskovic, a Belgrade cafe owner said he had fewer customers than usual, lamented his empty nonsmoking section — and pointing out his full smoking area.

I vividly recall such a scene in my local pub some years ago when the fiercely anti-smoking landlord decided to introduce a similar revenue-slashing measure.

Of course, you don't have to look far to find the real motive for the Serbian ban...

The law is a "step forward" for the country that aspires to be an EU member, argued Health Minister Tomica Milosavljevic. He said that "it is important that we try to act differently, to reduce the smoke around us."

Thursday, 11 November 2010

An anonymous commenter has alerted me to an article in the Financial Timescalling for an end to "propaganda disguised as science". Most aptly, it cites the heart miracles of England and Scotland as cases in point:

What of the claim that the smoking ban reduced the incidence of what lay people call heart attacks in England by 2.4 per cent? This follows the more extravagant claim that the similar ban in Scotland had an effect of 17 per cent. The evidence for the former proposal is weak, and the latter claim is implausible. The incidence of heart attacks is falling steadily in both countries by around 3 to 4 per cent per year, with fluctuations but no obvious break in this trend. Better health education and reduction in smoking are part of the explanation.

In the year after the English ban, the fall in reported cases was 4.3 per cent. The effect claimed for the ban is the difference between the actual figure and that predicted by a model constructed by the researchers. In Scotland there was an above average fall in heart attacks – though nearer 7 per cent than 17 per cent – immediately after the ban, but this seems to have been a freak, since it was reversed the following year. The researchers derived their conclusions from a specially compiled dataset constructed over a limited period.

All of which will be familiar to regular readers of Spiked and of this blog (eg. here and here).

The studies I have cited are carefully referenced and use advanced statistical techniques. But sophistication of method is used to torture data to reveal conclusions that do not obviously follow from them, but which fit either the researchers’ preconceptions or the sponsor’s policy objectives, or both.

Indeed so. "Advanced statistical techniques" cover a multitude of sins. Far from providing empirical evidence, they offer unlimited scope for manipulation and require blind faith in return—the classic case being Anna Gilmore's risible computer model (which claims to be able to predict the annual number of heart attacks based on nothing but average air temperature and knowing which day of the week Christmas falls on).

Bad arguments do not necessarily invalidate the causes in which they are deployed. People should not drink and drive. Smoking is unpleasant and perhaps harmful to non-smokers. But these observations do not justify blurring the distinction between genuine scientific analysis and propaganda disguised as science. Policy should follow evidence, not evidence policy. It is time to reassert the principle that research must pursue the truth wherever it leads: the principle on which the social and economic progress of the past few centuries has depended.

Well said, that man. That man being John Kay, professor of economics at the London Business School, with whom I am already familiar since he is one of several serious academics to have criticised The Spirit Level—another fine example of propaganda disguised as science. He said of that book:

"The evidence presented in the book is mostly a series of scatter diagrams with a regression line drawn through them. No data is provided on the estimated equations, or on relevant statistical tests. If you remove the bold lines from the diagram, the pattern of points mostly looks random, and the data dominated by a few outliers."

As usual, when presented with substantive criticism, The Spirit Level's authors resorted to feeble put-downs "He didn't read the book thoroughly, obviously," Kate Pickett said of the Financial Times' book reviewer (on the BBC's More or Lessprogramme).

And they're at it again today in the New Statesman, plumbing new depths of ad hominem:

In their book Merchants of Doubt, the American academics Naomi Oreskes and Erik Conway suggest that the defence of a kind of free-market fundamentalism is the most plausible explanation of why the same individuals and institutions are often involved in attacks on research in areas as diverse as tobacco control and the evidence on climate change. As well as defending the free market, they see themselves as countering tendencies to big government and protecting democracy. The same beliefs are likely to guide the attacks on the evidence of inequality's socially damaging effects.

This is an incoherent, self-aggrandising and paranoid argument. Incoherent because The Spirit Level has been criticised from people across the political spectrum, including John Kay who is "sympathetic to its basic stance". It is self-aggrandising because it equates their own social science with the physical sciences, and paranoid because even if such a cadre of powerful 'free-market fundamentalists" (ie. anyone to the right of them) existed, they would scarcely bother to direct their fire at a soft target like The Spirit Level.

To tie this fantasy together with the phrase "the same beliefs are likely to guide attacks [on us]..." is to employ the weasliest of weasel words. But now that John Kay has implicitly criticised tobacco control (albeit in a very roundabout way), Wilkinson and Pickett can rest easy in the renewed belief that they are the subject of an organised rightwing posse, rather than a few individuals who bothered to test their claims.

Speaking of whom, while I was incommunicado I received an e-mail from Dr. Mick O'Connell at University College Dublin, who has also taken an interest in Wilkinson and Pickett's work ("I purchased their book with high hopes of a convincing read, and the disappointment in the content propelled me to write a critique.") His working paper is titled 'Affluence versus Equality? A critique of Wilkinson and Pickett’s book The Spirit Level' and can be downloaded here. This is a sample:

Part of the implicit Spirit Level thesis is an obsession with consumerism – the latter authors pinpoint “our consumerism [and] addiction to shopping and spending” (p. 221). One has to wonder whether these people have tried high-street shopping recently? Am I alone in thinking it borders on the hellish?

Shopping, like air travel, perhaps once conferred a kind of jetset mystique, a bit like cheesy-pineapples on a stick. But now the negotiation of a busy shopping mall, or a thronged airport is about as glamorous as, well, cheesy-pineapple appetizers. Most of us, I contend, dislike shopping, but do it because we have to, because the kids demand Cheerios, the baby needs Pampers and the cat gets pretty mean without her Whiskas.

Of course, there is also a small but determined subset of people who still like air travel or shopping. But these people should be seen for what they are - strange eccentrics, not a substantial social trend. How do we know this? Because shops have to spend a fortune advertising just to try to get us through their door, and change their look and design every year to persuade us to stay.

Our ‘addiction’ to brands is actually so slight that as soon as ‘hard discounters’ like Lidl and Aldi expanded beyond their German base into the European grocery market, they enjoyed spectacular success. ‘Hard discounters’ offer a limited product range and a predominance oflow-price generic brands. “Second-class goods make us look like second-class people” argues The Spirit Level, (p. 222) – this is why we’re supposed to be obsessed with luxury goods. Not a bit of it – decent low-priced goods make us look like smart and astute people. Bye-bye Whiskas, hallo Katzen-Imbiss!

Welcome back. After three weeks in India and two weeks in techno limbo, do I even have any readers left, I wonder?

A fortnight without internet access and a television signal is not the liberating experience the tree-huggers and back-to-the-landers suggest it is. In fact it sucks. And the first thing I see when I get a television picture back is news footage of a group of protestors holding a placard that read "No Fee's (sic)". Call me an old stick in the mud if you wish, but I can't sympathise with University students who put an apostrophe in a non-possessive plural. It does, however, reminds us what is at the root of the Higher Education's funding problem—too many people going to University. And when I say 'people', I mean 'illiterate cretins'.

Anyway, I also see that another European country is, ahem, going smokefree...

Serbia introduces tough smoking ban

Bearing in mind that Serbia is well outside of the Anglosphere, how 'tough' do you think this ban really is?

The law bans smoking in state institutions and buildings, schools, social care institutions, buildings used for cultural and sports activities, and media buildings.

Schools, hospitals and government buildings. OK. But what about the places where people actually want to smoke?

Smaller bars and cafes can decide to be smoke-free or not, while bigger ones, as well as restaurants have to provide a non-smoking space that would occupy more than a half of the premises and be properly ventilated.

And businesses?

Companies are allowed to provide a smoking area, but also to introduce anti-tobacco measures in all other spaces.

When I was in Budapest last year, I was interviewed by a woman who expressed surprise that while countries like Hungary were happily shaking off the yoke of Communism and embracing freedom, people in the West seem to be moving in the opposite direction, smoking bans being an obvious example. I didn't really have an answer for that. Nor can I explain why smoking bans are so much more popular on the left than the right (see this recent article in the uber-socialist Herald Tribune).

Meanwhile, a friend e-mails me from Israel:

It appears that there is a smoking ban in restaurants and pubs, although I went into one place, a kind of speak-easy underground joint hidden behind a normal wine shop—definitely not 'adequately ventilated'—everyone smoking away happy as Larry under big "no smoking" signs on the wall.

I was confused. I asked the barmaid for a beer—which came with a free whisky chaser!—then, being a polite Englishman, enquired after an ashtray. She said to just use the floor. Apparently it turns out the fine is on the individual not the establishment so some places choose to allow smoking if the police come knocking everyone chucks their fags on the floor—making it hard to prove the crime on anyone person.

Tuesday, 2 November 2010

Blogging will be light to non-existent for the next week or so, I'm afraid. I've just moved into a house which has no phone line, broadband or TV aerial and that ain't going to chance until next Thursday.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."